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Zhang YD, Zhou GL, Wang L, Browning MHEM, Markevych I, Heinrich J, Knibbs LD, Zhao T, Ding Y, Chen S, Liu KK, Dadvand P, Dong GH, Yang BY. Greenspace and human microbiota: A systematic review. ENVIRONMENT INTERNATIONAL 2024; 187:108662. [PMID: 38653130 DOI: 10.1016/j.envint.2024.108662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 02/13/2024] [Accepted: 04/15/2024] [Indexed: 04/25/2024]
Abstract
BACKGROUND Potential effect of greenspace exposure on human microbiota have been explored by a number of observational and interventional studies, but the results remained mixed. We comprehensively synthesized these studies by performing a systematic review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. METHODS Comprehensive literature searches in three international databases (PubMed, Embase, and Web of Science) and three Chinese databases (China National Knowledge Infrastructure, Wanfang, and China Biology Medicine disc) were conducted from inception to November 1, 2023. Observational and interventional studies that evaluated associations between greenspace exposure and human microbiota at different anatomical sites were included. Studies were assessed using the National Toxicology Program's office of Health Assessment and Translation risk of bias tool and certainty of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluation framework. Two authors independently performed study selection, data extraction, and risk of bias assessment, and evidence grading. Study results were synthesized descriptively. RESULTS Twenty studies, including 11 observational studies and 9 interventional studies, were finally included into the systematic review. The microbiota of the included studies was from gut (n = 13), skin (n = 10), oral cavity (n = 5), nasal cavity (n = 5) and eyes (n = 1). The majority of studies reported the associations of greenspace exposure with increased diversity (e.g., richness and Shannon index) and/or altered overall composition of human gut (n = 12) and skin microbiota (n = 8), with increases in the relative abundance of probiotics (e.g., Ruminococcaceae) and decreases in the relative abundance of pathogens (e.g., Streptococcus and Escherichia/Shigella). Due to limited number of studies, evidence concerning greenspace and oral, nasal, and ocular microbiota were still inconclusive. CONCLUSION The current evidence suggests that greenspace exposure may diversify gut and skin microbiota and alter their composition to healthier profiles. These findings would be helpful in uncovering the potential mechanisms underlying greenspace and human health and in promoting a healthier profile of human microbiota.
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Affiliation(s)
- Yi-Dan Zhang
- Joint International Research Laboratory of Environment and Health, Ministry of Education, Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment, Department of Occupational and Environmental Health, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Gang-Long Zhou
- Joint International Research Laboratory of Environment and Health, Ministry of Education, Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment, Department of Occupational and Environmental Health, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Lu Wang
- Joint International Research Laboratory of Environment and Health, Ministry of Education, Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment, Department of Occupational and Environmental Health, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Matthew H E M Browning
- Department of Park, Recreation, and Tourism Management, Clemson University, Clemson, SC 29634, USA
| | - Iana Markevych
- Institute of Psychology, Jagiellonian University, Krakow, Poland
| | - Joachim Heinrich
- Institute and Clinic for Occupational, Social and Environmental Medicine, LMU University Hospital Munich, Munich 80036, Germany; Allergy and Lung Health Unit, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC 3010, Australia
| | - Luke D Knibbs
- School of Public Health, The University of Sydney, Camperdown, NSW 2006, Australia; Public Health Research Analytics and Methods for Evidence, Public Health Unit, Sydney Local Health District, Camperdown, NSW 2025, Australia
| | - Tianyu Zhao
- Institute and Clinic for Occupational, Social and Environmental Medicine, LMU University Hospital Munich, Comprehensive Pneumology Center (CPC) Munich, German Center for Lung Research (DZL), Munich 80036, Germany; Institute of Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health, 85764 Neuherberg, Germany
| | - Yizhen Ding
- Department of Landscape Architecture and Urban Planning, Texas A&M University, College Station, TX 77843, USA
| | - Shi Chen
- School of Public Health, Sun Yat-Sen University, Guangzhou 510080, China
| | - Kang-Kang Liu
- Department of Research Center for Medicine, the Eighth Affiliated Hospital, Sun Yat-Sen University, Shenzhen, China
| | - Payam Dadvand
- ISGlobal, Dr. Aiguader 88, 08003 Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Guang-Hui Dong
- Joint International Research Laboratory of Environment and Health, Ministry of Education, Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment, Department of Occupational and Environmental Health, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Bo-Yi Yang
- Joint International Research Laboratory of Environment and Health, Ministry of Education, Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment, Department of Occupational and Environmental Health, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China.
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Aguilar-Lacasaña S, Fontes Marques I, de Castro M, Dadvand P, Escribà X, Fossati S, González JR, Nieuwenhuijsen M, Alfano R, Annesi-Maesano I, Brescianini S, Burrows K, Calas L, Elhakeem A, Heude B, Hough A, Isaevska E, W V Jaddoe V, Lawlor DA, Monaghan G, Nawrot T, Plusquin M, Richiardi L, Watmuff A, Yang TC, Vrijheid M, F Felix J, Bustamante M. Green space exposure and blood DNA methylation at birth and in childhood - A multi-cohort study. ENVIRONMENT INTERNATIONAL 2024; 188:108684. [PMID: 38776651 DOI: 10.1016/j.envint.2024.108684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 03/21/2024] [Accepted: 04/21/2024] [Indexed: 05/25/2024]
Abstract
Green space exposure has been associated with improved mental, physical and general health. However, the underlying biological mechanisms remain largely unknown. The aim of this study was to investigate the association between green space exposure and cord and child blood DNA methylation. Data from eight European birth cohorts with a total of 2,988 newborns and 1,849 children were used. Two indicators of residential green space exposure were assessed: (i) surrounding greenness (satellite-based Normalized Difference Vegetation Index (NDVI) in buffers of 100 m and 300 m) and (ii) proximity to green space (having a green space ≥ 5,000 m2 within a distance of 300 m). For these indicators we assessed two exposure windows: (i) pregnancy, and (ii) the period from pregnancy to child blood DNA methylation assessment, named as cumulative exposure. DNA methylation was measured with the Illumina 450K or EPIC arrays. To identify differentially methylated positions (DMPs) we fitted robust linear regression models between pregnancy green space exposure and cord blood DNA methylation and between cumulative green space exposure and child blood DNA methylation. Two sensitivity analyses were conducted: (i) without adjusting for cellular composition, and (ii) adjusting for air pollution. Cohort results were combined through fixed-effect inverse variance weighted meta-analyses. Differentially methylated regions (DMRs) were identified from meta-analysed results using the Enmix-combp and DMRcate methods. There was no statistical evidence of pregnancy or cumulative exposures associating with any DMP (False Discovery Rate, FDR, p-value < 0.05). However, surrounding greenness exposure was inversely associated with four DMRs (three in cord blood and one in child blood) annotated to ADAMTS2, KCNQ1DN, SLC6A12 and SDK1 genes. Results did not change substantially in the sensitivity analyses. Overall, we found little evidence of the association between green space exposure and blood DNA methylation. Although we identified associations between surrounding greenness exposure with four DMRs, these findings require replication.
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Affiliation(s)
- Sofia Aguilar-Lacasaña
- ISGlobal, Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública, Spain; Universitat de Barcelona, Barcelona, Spain.
| | - Irene Fontes Marques
- Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands; Department of Pediatrics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Montserrat de Castro
- ISGlobal, Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública, Spain
| | - Payam Dadvand
- ISGlobal, Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública, Spain
| | - Xavier Escribà
- ISGlobal, Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública, Spain
| | - Serena Fossati
- ISGlobal, Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública, Spain
| | - Juan R González
- ISGlobal, Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública, Spain
| | - Mark Nieuwenhuijsen
- ISGlobal, Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública, Spain
| | - Rossella Alfano
- Centre for Environmental Sciences, Hasselt University, Agoralaan Building D, 3590, Diepenbeek, Belgium
| | - Isabella Annesi-Maesano
- Desbrest Institute of Epidemiology and Public Health (IDESP), Montpellier University and Inserm, Montpellier, Service des Maladies Allergiques et Respiratoires, CHU, Montpellier, France
| | - Sonia Brescianini
- Centre for Behavioural Science and Mental Health, Istituto Superiore di Sanità, Rome, Italy
| | - Kimberley Burrows
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Lucinda Calas
- Université Paris Cité and Université Sorbonne Paris Nord, Inserm, INRAE, Center for Research in Epidemiology and StatisticS (CRESS), F-75004 Paris, France
| | - Ahmed Elhakeem
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Barbara Heude
- Université Paris Cité and Université Sorbonne Paris Nord, Inserm, INRAE, Center for Research in Epidemiology and StatisticS (CRESS), F-75004 Paris, France
| | - Amy Hough
- Born in Bradford, Wolfson Centre for Applied Health Research, Bradford Royal Infirmary, Bradford, UK
| | - Elena Isaevska
- Department of Pediatrics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands; Department of Medical Sciences, University of Turin, CPO-Piemonte, Turin, Italy
| | - Vincent W V Jaddoe
- Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands; Department of Pediatrics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Deborah A Lawlor
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK; Medical Research Council Integrative Epidemiology Unit at the University of Bristol, Bristol, UK
| | - Genevieve Monaghan
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Tim Nawrot
- Centre for Environmental Sciences, Hasselt University, Agoralaan Building D, 3590, Diepenbeek, Belgium; Department of Public Health, Leuven University (KU Leuven), Leuven, Belgium
| | - Michelle Plusquin
- Centre for Environmental Sciences, Hasselt University, Agoralaan Building D, 3590, Diepenbeek, Belgium
| | - Lorenzo Richiardi
- Department of Medical Sciences, University of Turin, CPO-Piemonte, Turin, Italy
| | - Aidan Watmuff
- Born in Bradford, Wolfson Centre for Applied Health Research, Bradford Royal Infirmary, Bradford, UK
| | - Tiffany C Yang
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, UK
| | - Martine Vrijheid
- ISGlobal, Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública, Spain
| | - Janine F Felix
- Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands; Department of Pediatrics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Mariona Bustamante
- ISGlobal, Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública, Spain
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Yu Y, Lin H, Liu Q, Ma Y, Zhao L, Li W, Zhou Y, Byun HM, Li P, Li C, Sun C, Chen X, Liu Z, Dong W, Chen L, Deng F, Wu S, Hou S, Guo L. Association of residential greenness, air pollution with adverse birth outcomes: Results from 61,762 mother‑neonatal pairs in project ELEFANT (2011-2021). THE SCIENCE OF THE TOTAL ENVIRONMENT 2024; 912:169549. [PMID: 38145684 DOI: 10.1016/j.scitotenv.2023.169549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Revised: 11/06/2023] [Accepted: 12/18/2023] [Indexed: 12/27/2023]
Abstract
BACKGROUND Emerging evidence has demonstrated the benefits of greenness exposure on human health, while conflicts remain unsolved in issue of adverse birth outcomes. METHODS Utilizing data from project ELEFANT spanning the years 2011 to 2021, we assessed residential greenness using the NDVI from MODIS data and residential PM2.5 exposure level from CHAP data. Our primary concerns were PTD, LBW, LGA, and SGA. Cox proportional hazard regression model was used to examine the association of residential greenness and air pollution exposure with risk of adverse birth outcomes. We performed mediation and modification effect analyses between greenness and air pollutant. RESULTS We identified 61,762 mother‑neonatal pairs in final analysis. For per 10 μg/m3 increase in PM2.5 concentration during entire pregnancy was associated with 19.8 % and 20.7 % increased risk of PTD and LGA. In contrast, we identified that an 0.1 unit increment in NDVI were associated with 24 %, 43 %, 26.5 %, and 39.5 % lower risk for PTD, LBW, LGA, and SGA, respectively. According to mediation analysis, NDVI mediated 7.70 % and 7.89 % of the associations between PM2.5 and PTD and LGA. Residential greenness could reduce the risk of PTD among mothers under 35 years old, living in rural areas, primigravidae and primiparity.. CONCLUSIONS In summary, our results highlighted the potential of residential greenness to mitigate the risk of adverse birth outcomes, while also pointing to the adverse impact of PM2.5 on increased risk of multiple adverse birth outcomes (PTD and LGA). The significant mediation effect of NDVI emphasizes its potential as an important protective factor of PM2.5 exposure. Additionally, the identification of susceptible subgroups can inform targeted interventions to reduce adverse birth outcomes related to air pollution and lack of green spaces. Further research and understanding of these associations can contribute to better public health strategies aimed at promoting healthier pregnancies and birth outcomes.
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Affiliation(s)
- Yuanyuan Yu
- Institute of Disaster and Emergency Medicine, Tianjin University, Tianjin 300072, China; Wenzhou Safety (Emergency) Institute, Tianjin University, Wenzhou 325000, China; Tianjin Key Laboratory of Disaster Medicine Technology, Tianjin, China
| | - Huishu Lin
- Institute of Disaster and Emergency Medicine, Tianjin University, Tianjin 300072, China; Wenzhou Safety (Emergency) Institute, Tianjin University, Wenzhou 325000, China; Tianjin Key Laboratory of Disaster Medicine Technology, Tianjin, China
| | - Qisijing Liu
- Research Institute of Public Health, School of Medicine, Nankai University, Tianjin, China
| | - Yuxuan Ma
- Institute of Disaster and Emergency Medicine, Tianjin University, Tianjin 300072, China; Wenzhou Safety (Emergency) Institute, Tianjin University, Wenzhou 325000, China; Tianjin Key Laboratory of Disaster Medicine Technology, Tianjin, China
| | - Lei Zhao
- Institute of Disaster and Emergency Medicine, Tianjin University, Tianjin 300072, China; Wenzhou Safety (Emergency) Institute, Tianjin University, Wenzhou 325000, China; Tianjin Key Laboratory of Disaster Medicine Technology, Tianjin, China
| | - Weixia Li
- Institute of Disaster and Emergency Medicine, Tianjin University, Tianjin 300072, China; Wenzhou Safety (Emergency) Institute, Tianjin University, Wenzhou 325000, China; Tianjin Key Laboratory of Disaster Medicine Technology, Tianjin, China
| | - Yan Zhou
- School of Pharmaceutical Science and Technology, Tianjin University, Tianjin 300072, China
| | - Hyang-Min Byun
- Human Nutrition Research Centre, Institute of Cellular Medicine, Newcastle University, Campus for Ageing and Vitality, Newcastle Upon Tyne NE4 5PL, UK
| | - Penghui Li
- Department of Environmental Science, School of Environmental Science and Safety Engineering, Tianjin University of Technology, Tianjin, China
| | - Chen Li
- Department of Occupational and Environmental Health, School of Public Health, Tianjin Medical University, Tianjin, China; Tianjin Key Laboratory of Environment, Nutrition and Public Health, School of Public Health, Tianjin Medical University, Tianjin, China
| | - Congcong Sun
- Department of Scientific Research Center, The Third Clinical Institute Affiliated of Wenzhou Medical University, The Third Affiliated of Shanghai University, Wenzhou People's Hospital, Wenzhou Maternal and Child Health Care Hospital, Wenzhou, China
| | - Xuemei Chen
- Institute of Disaster and Emergency Medicine, Tianjin University, Tianjin 300072, China; Wenzhou Safety (Emergency) Institute, Tianjin University, Wenzhou 325000, China; Tianjin Key Laboratory of Disaster Medicine Technology, Tianjin, China
| | - Ziquan Liu
- Institute of Disaster and Emergency Medicine, Tianjin University, Tianjin 300072, China; Wenzhou Safety (Emergency) Institute, Tianjin University, Wenzhou 325000, China; Tianjin Key Laboratory of Disaster Medicine Technology, Tianjin, China
| | - Wenlong Dong
- Institute of Disaster and Emergency Medicine, Tianjin University, Tianjin 300072, China; Wenzhou Safety (Emergency) Institute, Tianjin University, Wenzhou 325000, China
| | - Liqun Chen
- Academy of Medical Engineering and Translational Medicine, Medical College, Tianjin University, Tianjin 300072, China
| | - Furong Deng
- Department of Occupational and Environmental Health Sciences, School of Public Health, Peking University, Beijing, China
| | - Shaowei Wu
- Department of Occupational and Environmental Health, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, China
| | - Shike Hou
- Institute of Disaster and Emergency Medicine, Tianjin University, Tianjin 300072, China; Wenzhou Safety (Emergency) Institute, Tianjin University, Wenzhou 325000, China; Tianjin Key Laboratory of Disaster Medicine Technology, Tianjin, China.
| | - Liqiong Guo
- Institute of Disaster and Emergency Medicine, Tianjin University, Tianjin 300072, China; Wenzhou Safety (Emergency) Institute, Tianjin University, Wenzhou 325000, China; Tianjin Key Laboratory of Disaster Medicine Technology, Tianjin, China.
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Wei N, Wang S, Li X, Pan R, Yi W, Song J, Liu L, Liu J, Yuan J, Song R, Cheng J, Su H. The association between greenery type and gut microbiome in schizophrenia: did all greenspaces play the equivalent role? ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2023; 30:100006-100017. [PMID: 37624502 DOI: 10.1007/s11356-023-29419-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 08/17/2023] [Indexed: 08/26/2023]
Abstract
In recent years, attention has been focused on the benefit of greenspace on mental health, and it is suggested this link may vary with the type of greenspace. More and more studies have emphasized the influence of the gut microbiome on schizophrenia (SCZ). However, the effects of greenspaces on the gut microbiota in SCZ and the effect of different types of greenspaces on the gut microbiota remain unclear. We aim to examine if there were variations in the effects of various greenspace types on the gut microbiome in SCZ. Besides, we sink to explore important taxonomic compositions associated with different greenspace types. We recruited 243 objects with schizophrenia from Anhui Mental Health Center and collected fecal samples for 16Sr RNA gene sequencing. Three types of greenery coverage were calculated with different circular buffers (800, 1500, and 3000 m) corresponding to individual addresses. The association between greenspace and microbiome composition was analyzed with permutational analysis of variance (PERMANOVA). We conducted the linear regression to capture specific gut microbiome taxa associated with greenery coverage. Tree coverage was consistently associated with microbial composition in both 1500 m (R2 = 0.007, P = 0.030) and 3000 m (R2 = 0.007, P = 0.039). In contrast, there was no association with grass cover in any of the buffer zones. In the regression analysis, higher tree coverage was significantly correlated with the relative abundance of several taxa. Among them, tree coverage was positively associated with increased Bifidobacterium longum (β = 1.069, P = 0.004), which was the dominant composition in the gut microbiota. The relationship between greenspace and gut microbiome in SCZ differed by the type of greenspace. Besides, "tree coverage" may present a dominant effect on the important taxonomic composition. Our findings might provide instructive evidence for the design of urban greenspace to optimize health and well-being in SCZ as well as the whole people.
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Affiliation(s)
- Ning Wei
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, 230032, Anhui, China
- Anhui Province Key Laboratory of Major Autoimmune Disease, Hefei, 230032, Anhui, China
| | - Shusi Wang
- Hefei Stomatological Hospital, Anhui Medical University, Hefei, 230032, Anhui, China
| | - Xuanxuan Li
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, 230032, Anhui, China
- Anhui Province Key Laboratory of Major Autoimmune Disease, Hefei, 230032, Anhui, China
| | - Rubing Pan
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, 230032, Anhui, China
- Anhui Province Key Laboratory of Major Autoimmune Disease, Hefei, 230032, Anhui, China
| | - Weizhuo Yi
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, 230032, Anhui, China
- Anhui Province Key Laboratory of Major Autoimmune Disease, Hefei, 230032, Anhui, China
| | - Jian Song
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, 230032, Anhui, China
- Anhui Province Key Laboratory of Major Autoimmune Disease, Hefei, 230032, Anhui, China
| | - Li Liu
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, 230032, Anhui, China
- Anhui Province Key Laboratory of Major Autoimmune Disease, Hefei, 230032, Anhui, China
| | - Jintao Liu
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, 230032, Anhui, China
- Anhui Province Key Laboratory of Major Autoimmune Disease, Hefei, 230032, Anhui, China
| | - Jiajun Yuan
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, 230032, Anhui, China
- Anhui Province Key Laboratory of Major Autoimmune Disease, Hefei, 230032, Anhui, China
| | - Rong Song
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, 230032, Anhui, China
- Anhui Province Key Laboratory of Major Autoimmune Disease, Hefei, 230032, Anhui, China
| | - Jian Cheng
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, 230032, Anhui, China
- Anhui Province Key Laboratory of Major Autoimmune Disease, Hefei, 230032, Anhui, China
| | - Hong Su
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, 230032, Anhui, China.
- Anhui Province Key Laboratory of Major Autoimmune Disease, Hefei, 230032, Anhui, China.
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Motairek I, Makhlouf MHE, Rajagopalan S, Al-Kindi S. The Exposome and Cardiovascular Health. Can J Cardiol 2023; 39:1191-1203. [PMID: 37290538 PMCID: PMC10526979 DOI: 10.1016/j.cjca.2023.05.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 05/16/2023] [Accepted: 05/31/2023] [Indexed: 06/10/2023] Open
Abstract
The study of the interplay between social factors, environmental hazards, and health has garnered much attention in recent years. The term "exposome" was coined to describe the total impact of environmental exposures on an individual's health and well-being, serving as a complementary concept to the genome. Studies have shown a strong correlation between the exposome and cardiovascular health, with various components of the exposome having been implicated in the development and progression of cardiovascular disease. These components include the natural and built environment, air pollution, diet, physical activity, and psychosocial stress, among others. This review provides an overview of the relationship between the exposome and cardiovascular health, highlighting the epidemiologic and mechanistic evidence of environmental exposures on cardiovascular disease. The interplay between various environmental components is discussed, and potential avenues for mitigation are identified.
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Affiliation(s)
- Issam Motairek
- Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center and Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Mohamed H E Makhlouf
- Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center and Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Sanjay Rajagopalan
- Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center and Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Sadeer Al-Kindi
- Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center and Case Western Reserve University School of Medicine, Cleveland, Ohio, USA.
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Zhang YD, Fan SJ, Zhang Z, Li JX, Liu XX, Hu LX, Knibbs LD, Dadvand P, Jalaludin B, Browning MH, Zhao T, Heinrich J, He Z, Chen CZ, Zhou Y, Dong GH, Yang BY. Association between Residential Greenness and Human Microbiota: Evidence from Multiple Countries. ENVIRONMENTAL HEALTH PERSPECTIVES 2023; 131:87010. [PMID: 37585351 PMCID: PMC10431502 DOI: 10.1289/ehp12186] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 07/06/2023] [Accepted: 07/17/2023] [Indexed: 08/18/2023]
Abstract
BACKGROUND Greenness, referring to a measurement of the density of vegetated land (e.g., gardens, parks, grasslands), has been linked with many human health outcomes. However, the evidence on greenness exposure and human microbiota remains limited, inconclusive, drawn from specific regions, and based on only modest sample size. OBJECTIVES We aimed to study the association between greenness exposure and human microbial diversity and composition in a large sample across 34 countries and regions. METHODS We explored associations between residential greenness and human microbial alpha-diversity, composition, and genus abundance using data from 34 countries. Greenness exposure was assessed using the normalized difference vegetation index and the enhanced vegetation index mean values in the month before sampling. We used linear regression models to estimate the association between greenness and microbial alpha-diversity and tested the effect modification of age, sex, climate zone, and pet ownership of participants. Differences in microbial composition were tested by permutational multivariate analysis of variance based on Bray-Curtis distance and differential taxa were detected using the DESeq2 R package between two greenness exposure groups split by median values of greenness. RESULTS We found that higher greenness was significantly associated with greater richness levels in the palm and gut microbiota but decreased evenness in the gut microbiota. Pet ownership and climate zone modified some associations between greenness and alpha-diversity. Palm and gut microbial composition at the genus level also varied by greenness. Higher abundances of the genera Lactobacillus and Bifidobacterium, and lower abundances of the genera Anaerotruncus and Streptococcus, were observed in people with higher greenness levels. DISCUSSION These findings suggest that residential greenness was associated with microbial richness and composition in the human skin and gut samples, collected across different geographic contexts. Future studies may validate the observed associations and determine whether they correspond to improvements in human health. https://doi.org/10.1289/EHP12186.
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Affiliation(s)
- Yi-Dan Zhang
- Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment, Department of Occupational and Environmental Health, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Shu-Jun Fan
- Department of Environmental Health, Guangzhou Center for Disease Control and Prevention, Guangzhou, China
- Institute of Public Health, Guangzhou Medical University and Guangzhou Center for Disease Control and Prevention, Guangzhou, China
| | - Zheng Zhang
- Department of Central Laboratory, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, Beijing, China
| | - Jia-Xin Li
- Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment, Department of Occupational and Environmental Health, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Xiao-Xuan Liu
- Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment, Department of Occupational and Environmental Health, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Li-Xin Hu
- Department of Maternal and Child Health, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Luke D. Knibbs
- School of Public Health, University of Sydney, Camperdown, New South Wales, Australia
| | - Payam Dadvand
- ISGlobal, Barcelona, Spain
- Universitat Pompeu Fabra, Barcelona, Spain
- CIBER Epidemiología y Salud Pública, Madrid, Spain
| | - Bin Jalaludin
- School of Population Health, University of New South Wales, Kensington, New South Wales, Australia
| | - Matthew H.E.M. Browning
- Department of Park, Recreation, and Tourism Management, Clemson University, Clemson, South Carolina, USA
| | - Tianyu Zhao
- Institute and Clinic for Occupational, Social and Environmental Medicine, Hospital of the Ludwig-Maximilians-Universität München (LMU Munich), Munich, Germany
- Comprehensive Pneumology Center Munich, LMU Munich, Munich, Germany
- German Center for Lung Research, Justus Liebig University Giessen, Giessen, Germany
- Institute of Epidemiology, Helmholtz Zentrum München–German Research Center for Environmental Health, Neuherberg, Germany
| | - Joachim Heinrich
- Institute and Clinic for Occupational, Social and Environmental Medicine, LMU Munich, Munich, Germany
- Allergy and Lung Health Unit, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Zhini He
- Food Safety and Health Research Center, Guangdong Provincial Key Laboratory of Tropical Disease Research, School of Public Health, Southern Medical University, Guangzhou, China
| | - Cheng-Zhi Chen
- School of Public Health and Management, Research Center for Medicine and Social Development, Innovation Center for Social Risk Governance in Health, Chongqing Medical University, Chongqing, China
| | - Yuanzhong Zhou
- Department of Epidemiology, School of Public Health, Zunyi Medical University, Zunyi, China
| | - Guang-Hui Dong
- Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment, Department of Occupational and Environmental Health, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Bo-Yi Yang
- Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment, Department of Occupational and Environmental Health, School of Public Health, Sun Yat-sen University, Guangzhou, China
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Fu G, Ma G, Dou S, Wang Q, Fu L, Zhang X, Lu C, Cong B, Li S. Feature selection with a genetic algorithm can help improve the distinguishing power of microbiota information in monozygotic twins' identification. Front Microbiol 2023; 14:1210638. [PMID: 37555059 PMCID: PMC10406218 DOI: 10.3389/fmicb.2023.1210638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Accepted: 07/06/2023] [Indexed: 08/10/2023] Open
Abstract
INTRODUCTION Personal identification of monozygotic twins (MZT) has been challenging in forensic genetics. Previous research has demonstrated that microbial markers have potential value due to their specificity and long-term stability. However, those studies would use the complete information of detected microbial communities, and low-value species would limit the performance of previous models. METHODS To address this issue, we collected 80 saliva samples from 10 pairs of MZTs at four different time points and used 16s rRNA V3-V4 region sequencing to obtain microbiota information. The data formed 280 inner-individual (Self) or MZT sample pairs, divided into four groups based on the individual relationship and time interval, and then randomly divided into training and testing sets with an 8:2 ratio. We built 12 identification models based on the time interval ( ≤ 1 year or ≥ 2 months), data basis (Amplicon sequence variants, ASVs or Operational taxonomic unit, OTUs), and distance parameter selection (Jaccard distance, Bray-Curist distance, or Hellinger distance) and then improved their identification power through genetic algorithm processes. The best combination of databases with distance parameters was selected as the final model for the two types of time intervals. Bayes theory was introduced to provide a numerical indicator of the evidence's effectiveness in practical cases. RESULTS From the 80 saliva samples, 369 OTUs and 1130 ASVs were detected. After the feature selection process, ASV-Jaccard distance models were selected as the final models for the two types of time intervals. For short interval samples, the final model can completely distinguish MZT pairs from Self ones in both training and test sets. DISCUSSION Our findings support the microbiota solution to the challenging MZT identification problem and highlight the importance of feature selection in improving model performance.
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Affiliation(s)
- Guangping Fu
- College of Forensic Medicine, Hebei Medical University, Hebei Key Laboratory of Forensic Medicine, Research Unit of Digestive Tract Microecosystem Pharmacology and Toxicology, Chinese Academy of Medical Sciences, Shijiazhuang, China
| | - Guanju Ma
- College of Forensic Medicine, Hebei Medical University, Hebei Key Laboratory of Forensic Medicine, Research Unit of Digestive Tract Microecosystem Pharmacology and Toxicology, Chinese Academy of Medical Sciences, Shijiazhuang, China
| | - Shujie Dou
- College of Forensic Medicine, Hebei Medical University, Hebei Key Laboratory of Forensic Medicine, Research Unit of Digestive Tract Microecosystem Pharmacology and Toxicology, Chinese Academy of Medical Sciences, Shijiazhuang, China
| | - Qian Wang
- College of Forensic Medicine, Hebei Medical University, Hebei Key Laboratory of Forensic Medicine, Research Unit of Digestive Tract Microecosystem Pharmacology and Toxicology, Chinese Academy of Medical Sciences, Shijiazhuang, China
| | - Lihong Fu
- College of Forensic Medicine, Hebei Medical University, Hebei Key Laboratory of Forensic Medicine, Research Unit of Digestive Tract Microecosystem Pharmacology and Toxicology, Chinese Academy of Medical Sciences, Shijiazhuang, China
| | - Xiaojing Zhang
- College of Forensic Medicine, Hebei Medical University, Hebei Key Laboratory of Forensic Medicine, Research Unit of Digestive Tract Microecosystem Pharmacology and Toxicology, Chinese Academy of Medical Sciences, Shijiazhuang, China
| | - Chaolong Lu
- College of Forensic Medicine, Hebei Medical University, Hebei Key Laboratory of Forensic Medicine, Research Unit of Digestive Tract Microecosystem Pharmacology and Toxicology, Chinese Academy of Medical Sciences, Shijiazhuang, China
| | - Bin Cong
- College of Forensic Medicine, Hebei Medical University, Hebei Key Laboratory of Forensic Medicine, Research Unit of Digestive Tract Microecosystem Pharmacology and Toxicology, Chinese Academy of Medical Sciences, Shijiazhuang, China
- Hainan Tropical Forensic Medicine Academician Workstation, Haikou, China
| | - Shujin Li
- College of Forensic Medicine, Hebei Medical University, Hebei Key Laboratory of Forensic Medicine, Research Unit of Digestive Tract Microecosystem Pharmacology and Toxicology, Chinese Academy of Medical Sciences, Shijiazhuang, China
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Van Pee T, Nawrot TS, van Leeuwen R, Hogervorst J. The Gut Microbiome and Residential Surrounding Greenness: a Systematic Review of Epidemiological Evidence. Curr Environ Health Rep 2023:10.1007/s40572-023-00398-4. [PMID: 37296363 DOI: 10.1007/s40572-023-00398-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2023] [Indexed: 06/12/2023]
Abstract
PURPOSE OF REVIEW A healthy indigenous intestinal microbiome is essential for human health. Well-established gut microbiome determinants only explain 16% of the inter-individual variation in gut microbiome composition. Recent studies have focused on green space as a potential determinant of the intestinal microbiome. We systematically summarize all evidence concerning the association between green space and intestinal bacterial diversity, evenness, and richness indices, specific bacterial taxa, and potential underlying mechanisms. RECENT FINDINGS Seven epidemiological studies were included in this review. The majority of the included studies (n = 4) reported a positive association between green space and intestinal bacterial diversity, evenness, and richness, while two reported the opposite. There was little overlap between the publications regarding the association between green space and the relative abundance of specific bacterial taxa. Only a decrease in the relative abundance of Bacteroidetes, Bacteroides, and Anaerostipes and an increase in Lachnospiraceae and Ruminococcaceae were reported in multiple studies, predominantly suggesting that green space is positively associated with the intestinal microbiome composition, and subsequently with human health. Lastly, the only examined mechanism was a reduction in perceived psychosocial stress. Mechanisms indicated in blue and white represent tested or hypothesized mechanisms, respectively. The graphical abstract was created with illustrations from BioRender, Noun Project, and Pngtree.
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Affiliation(s)
- Thessa Van Pee
- Centre for Environmental Sciences, Hasselt University, Agoralaan Building D, 3590, Diepenbeek, Belgium
| | - Tim S Nawrot
- Centre for Environmental Sciences, Hasselt University, Agoralaan Building D, 3590, Diepenbeek, Belgium.
- Department of Public Health and Primary Care, Leuven University, Herestraat 49-Box 706, 3000, Louvain, Belgium.
| | - Romy van Leeuwen
- Centre for Environmental Sciences, Hasselt University, Agoralaan Building D, 3590, Diepenbeek, Belgium
| | - Janneke Hogervorst
- Centre for Environmental Sciences, Hasselt University, Agoralaan Building D, 3590, Diepenbeek, Belgium
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Avizemel O, Frishman S, Pinto Y, Michael Y, Turjeman S, Tenenbaum-Gavish K, Yariv O, Peled Y, Poran E, Pardo J, Chen R, Hod M, Schwartz B, Hadar E, Koren O, Agay-Shay K. "Residential greenness, gestational diabetes mellitus (GDM) and microbiome diversity during pregnancy". Int J Hyg Environ Health 2023; 251:114191. [PMID: 37290331 DOI: 10.1016/j.ijheh.2023.114191] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Revised: 04/11/2023] [Accepted: 05/22/2023] [Indexed: 06/10/2023]
Abstract
BACKGROUND Gestational diabetes mellitus (GDM) is associated with reduced gut microbiota richness that was also reported to differ significantly between those living in rural compared to urban environments. Therefore, our aim was to examine the associations between greenness and maternal blood glucose levels and GDM, with microbiome diversity as a possible mediator in these associations. METHODS Pregnant women were recruited between January 2016 and October 2017. Residential greenness was evaluated as mean Normalized Difference Vegetation Index (NDVI) within 100, 300 and 500 m buffers surrounding each maternal residential address. Maternal glucose levels were measured at 24-28 weeks of gestation and GDM was diagnosed. We estimated the associations between greenness and glucose levels and GDM using generalized linear models, adjusting for socioeconomic status and season at last menstrual period. Using causal mediation analysis, the mediation effects of four different indices of microbiome alpha diversity in first trimester stool and saliva samples were assessed. RESULTS Of 269 pregnant women, 27 participants (10.04%) were diagnosed with GDM. Although not statistically significant, adjusted exposure to medium tertile levels of mean NDVI at 300 m buffer had lower odds of GDM (OR = 0.45, 95% CI: 0.16, 1.26, p = 0.13) and decreased change in mean glucose levels (β = -6.28, 95% CI: 14.91, 2.24, p = 0.15) compared to the lowest tertile levels of mean NDVI. Mixed results were observed at 100 and 500 m buffers, and when comparing highest tertile levels to lowest. No mediation effect of first trimester microbiome on the association between residential greenness and GDM was observed, and a small, possibly incidental, mediation effect on glucose levels was observed. CONCLUSION Our study suggests possible associations between residential greenness and glucose intolerance and risk of GDM, though without sufficient evidence. Microbiome in the first trimester, while involved in GDM etiology, is not a mediator in these associations. Future studies in larger populations should further examine these associations.
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Affiliation(s)
- Ofir Avizemel
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel; The Health & Environment Research (HER) Lab, Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel.
| | - Sigal Frishman
- Institute of Biochemistry, School of Nutritional Sciences Food Science and Nutrition, The School of Nutritional Sciences, The Robert H. Smith Faculty of Agriculture, Food and Environment, The Hebrew University of Jerusalem, Rehovot, Israel; Helen Schneider Hospital for Women, Rabin Medical Center and Sackler Faculty of Medicine, Tel-Aviv University, Israel
| | - Yishay Pinto
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Yaron Michael
- Department of Soil & Water Sciences, Institute of Environmental Sciences, the Robert H. Smith Faculty of Agriculture, Food and Environment, The Hebrew University of Jerusalem, Rehovot, Israel
| | - Sondra Turjeman
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Kinneret Tenenbaum-Gavish
- Helen Schneider Hospital for Women, Rabin Medical Center and Sackler Faculty of Medicine, Tel-Aviv University, Israel
| | - Or Yariv
- Department of Soil & Water Sciences, Institute of Environmental Sciences, the Robert H. Smith Faculty of Agriculture, Food and Environment, The Hebrew University of Jerusalem, Rehovot, Israel
| | - Yoav Peled
- Helen Schneider Hospital for Women, Rabin Medical Center and Sackler Faculty of Medicine, Tel-Aviv University, Israel; Clalit Medical Services, Dan Petach-Tikva District, Israel
| | - Eran Poran
- Clalit Medical Services, Dan Petach-Tikva District, Israel
| | - Joseph Pardo
- Helen Schneider Hospital for Women, Rabin Medical Center and Sackler Faculty of Medicine, Tel-Aviv University, Israel; Clalit Medical Services, Dan Petach-Tikva District, Israel
| | - Rony Chen
- Helen Schneider Hospital for Women, Rabin Medical Center and Sackler Faculty of Medicine, Tel-Aviv University, Israel
| | - Moshe Hod
- Helen Schneider Hospital for Women, Rabin Medical Center and Sackler Faculty of Medicine, Tel-Aviv University, Israel
| | - Betty Schwartz
- Institute of Biochemistry, School of Nutritional Sciences Food Science and Nutrition, The School of Nutritional Sciences, The Robert H. Smith Faculty of Agriculture, Food and Environment, The Hebrew University of Jerusalem, Rehovot, Israel
| | - Eran Hadar
- Helen Schneider Hospital for Women, Rabin Medical Center and Sackler Faculty of Medicine, Tel-Aviv University, Israel
| | - Omry Koren
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Keren Agay-Shay
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel; The Health & Environment Research (HER) Lab, Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel.
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Xu Q, Li D, Chen J, Yang J, Yan J, Xia Y, Zhang F, Wang X, Cao H. Crosstalk between the gut microbiota and postmenopausal osteoporosis: Mechanisms and applications. Int Immunopharmacol 2022; 110:108998. [PMID: 35785728 DOI: 10.1016/j.intimp.2022.108998] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Revised: 06/08/2022] [Accepted: 06/21/2022] [Indexed: 12/14/2022]
Abstract
Postmenopausal osteoporosis (PMO) results from a reduction in bone mass and microarchitectural deterioration in bone tissue due to estrogen deficiency, which may increase the incidence of fragility fractures. The number of people suffering from PMO has increased over the years because of the rapidly aging population worldwide. However, several pharmacological agents for the treatment of PMO have many safety risks and impose a heavy financial burden to patients and society. In recent years, the "gut-bone" axis has been proposed as a new approach in the prevention and treatment of PMO. This paper reviews the relationship between the gut microbiota and PMO, which mainly includes the underlying mechanisms between hormones, immunity, nutrient metabolism, metabolites of the gut microbiota and intestinal permeability, and explores the possible role of the gut microbiota in these processes. Finally, we discuss the therapeutic effects of diet, prebiotics, probiotics, and fecal microbiota transplantation on the gut microbiota.
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Affiliation(s)
- Qin Xu
- Nutrition Department, Affiliated Hospital of Jiangnan University, Wuxi, Jiangsu, China; Wuxi School of Medicine, Jiangnan University, Wuxi, Jiangsu, China
| | - Dan Li
- Nutrition Department, Affiliated Hospital of Jiangnan University, Wuxi, Jiangsu, China; Wuxi School of Medicine, Jiangnan University, Wuxi, Jiangsu, China; Clinical Assessment Center of Functional Food, Affiliated Hospital of Jiangnan University, Wuxi, Jiangsu, China
| | - Jing Chen
- Wuxi School of Medicine, Jiangnan University, Wuxi, Jiangsu, China; Nursing Department, Affiliated Hospital of Jiangnan University, Wuxi, Jiangsu, China
| | - Ju Yang
- Nutrition Department, Affiliated Hospital of Jiangnan University, Wuxi, Jiangsu, China; Wuxi School of Medicine, Jiangnan University, Wuxi, Jiangsu, China; Clinical Assessment Center of Functional Food, Affiliated Hospital of Jiangnan University, Wuxi, Jiangsu, China
| | - Jiai Yan
- Nutrition Department, Affiliated Hospital of Jiangnan University, Wuxi, Jiangsu, China; Wuxi School of Medicine, Jiangnan University, Wuxi, Jiangsu, China; Clinical Assessment Center of Functional Food, Affiliated Hospital of Jiangnan University, Wuxi, Jiangsu, China
| | - Yanping Xia
- Nutrition Department, Affiliated Hospital of Jiangnan University, Wuxi, Jiangsu, China; Clinical Assessment Center of Functional Food, Affiliated Hospital of Jiangnan University, Wuxi, Jiangsu, China
| | - Feng Zhang
- Nutrition Department, Affiliated Hospital of Jiangnan University, Wuxi, Jiangsu, China; Wuxi School of Medicine, Jiangnan University, Wuxi, Jiangsu, China; Clinical Assessment Center of Functional Food, Affiliated Hospital of Jiangnan University, Wuxi, Jiangsu, China
| | - Xuesong Wang
- Nutrition Department, Affiliated Hospital of Jiangnan University, Wuxi, Jiangsu, China; Wuxi School of Medicine, Jiangnan University, Wuxi, Jiangsu, China; Clinical Assessment Center of Functional Food, Affiliated Hospital of Jiangnan University, Wuxi, Jiangsu, China; Department of Orthopedics, Affiliated Hospital of Jiangnan University, Wuxi, Jiangsu, China
| | - Hong Cao
- Nutrition Department, Affiliated Hospital of Jiangnan University, Wuxi, Jiangsu, China; Wuxi School of Medicine, Jiangnan University, Wuxi, Jiangsu, China; Clinical Assessment Center of Functional Food, Affiliated Hospital of Jiangnan University, Wuxi, Jiangsu, China; Department of Endocrinology, Affiliated Hospital of Jiangnan University, Wuxi, Jiangsu, China.
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